Tuesday, June 21, 2011

When I was seven It was less mountains and more mole hills. Life was contracted and small. Confined to a few walls. Two brothers. My parents. My father was my hero. And one day I told him....when I grow up, I will be a doctor.

When I was seventeen my father had already died. Finishing high school I was on the cusp of starting college. And climbing was more about ladders. Moving up. Fulfilling my father's destiny which had been cut short prematurely. When I finish college I will start medical school.

When I was twenty seven I looked outside the hospital windows and watched the construction. Each year of residency measured by a new ward, a new wing, a new building taking form above our entrenched front. And I saw my future. Rising on the horizon vaulting above the concrete, inching towards the sky. When I graduate from residency I will become an attending physician.

And now I am finishing my thirty seventh year. Again my life has become contracted. Mountains have been replaced by birthdays and weekends at the park. My hopes and dreams for my children have replaced my own. And for the first time in my life I no longer know what to strive for.

But sometimes. In the waning moments before sleep washes over my seven year old sons fatigued body...he looks up at me as I tuck him into bed. His eye half closed his lips part and his voice is almost a whisper...

Thursday, June 16, 2011

He was gregarious. And joyful. And he loved me. Like some of my patients. I couldn't do any wrong. His last doctor had dropped him because he had decided on alternative medicine to treat his heart disease. But I...I accepted him where he was. I explained the positives and negatives of traditional care. I informed him of risks and benefits but respected his personal choices even though they were very different from my own.

We joked in the exam room. About the complications of aging. He wasn't afraid of death, in fact he was in his eighth decade and welcomed the idea of change. He was undaunted.

So when he came to see me the other day I was unperturbed. We exchanged our usual banter and he started to give me one of his never ending litany of compliments but the he surprised me.

"You know doc...I met a guy the other day. A young guy who had just had his chest opened up and his valves repaired. And he was complaining about his doctor....So I told him he had to come see my doctor...Doctor G."

The he paused and looked at me appetisingly and started to imitate his companions response, "Dr. G....that guy almost killed me!"

I sat stunned for a moment. It is not unusual that when you care for thousands of patients that occasionally one of them doesn't like you. Eventually you meet people that you don't gel with. Some of them accuse you. Some of them don't understand that you did all you could. Some of them just don't like you.

But as I thought more about it I started to feel a great deal of anxiety. What if there is a patient out there that I hurt. That I missed a diagnosis and no one ever told me. That the patient went to another doctor who saved his life and I totally missed the boat. Could this happen? How often?

I gently pressed my patient further but he was unwilling to give me his friends name. Unable to give me the details.

Medicine can be disjointed. How often have I caught diagnosis that other doctors missed but failed to call them and inform them. It happens quite often.

Have I been too cavalier? Have I been to confident in my own abilities?

Tuesday, June 14, 2011

I was never really one to stand out. Growing up. I was quiet. I certainly didn't garner the attention of the opposite sex. I got used to it. Being anonymous. Being the kind of guy that girls liked for his personality. Certainly not for his looks.

But then something happened. Maybe it was the long doctors coat. Or the title. "Dr. Grumet". It kind of has a ring to it. And women paid attention. In the office. In the hospital. All of the sudden I was being noticed.

Of course, I new it was the persona. People look up to physicians because their standing in society, the power. It really wasn't about me.

The flirting however has now become obvious. The stolen glances in the exam room. The awkward conversation. The gentle lingering when I shake hands.

But I brush it off. As professional as ever. I Ignore the overt gestures. And pretend that I don't know.

And when the visit is over I help them off the exam table and deliver them safely back to their walkers and explain to their loved ones that their dementia has not worsened...much.

As I move on to the next patient I sigh with relief as I look at the face sheet....under sixty...nothing to worry about there!

Sunday, June 12, 2011

It's been a hard week. After 13 days straight. Getting up at 5am and pulling myself out of bed every morning as the rest of the household sleeps. One of those weeks I would rather forget. Lots of regret. Lots of worry. And certainly heartache.

And even on my day off it continued. A quick call to the ICU confirmed what I had feared all along. As the tension in my neck became unbearable the headache set in. My mood soured. My wife cautiously appraised me from the drivers seat as I became quiet. The kids argued in the backseat.

I had had enough. By 5pm I was ready to shut the world out. Close the doors and turn of the lights and call it a day. But there was a birthday party for my son and daughter. Of all things an ice skating party. And I didn't have the heart to stay home alone.

So we dragged the kids into the car. Put them in their car seats. Made our way to the skating rink.

My wife rented skates for herself and the kids, and I moped on the sidelines. As I walked into the observation area the cold air whipped across my face like a slap. It woke me up. It bayed me to come.

I walked hurriedly out the door and back to the check in area. I grabbed an old pair of beat up skates and raced to the rink. I laced up the skates with great clumsiness and inefficiency. Being that I had only skated once in the last twenty years I wasn't all that confident in my abilities.

I gingerly inched out on the ice and something amazing happened. My mind became totally engrossed in the activity. My neck muscles relaxed and my shoulders loosened. My legs moved rhythmically across the ice as my body swayed back and forth with each kick.

And I forgot. I forgot the horrendous sadness I had encountered last week. I forgot the sorrow and fatigue and stress. For a second I let go of the complexities of adulthood....of being a physician....and I was a child again. swirling through the air with ease and abandonment.

Thursday, June 9, 2011

My spindly legs dangle absentmindedly off the bottom bunk of the bunk bed. It was Michigan or Wisconsin or somewhere close to Chicago. I gently lean back on my wrists almost touching my father who is lying comfortabley next to me. He pulls on my arm and I fall backwards and land in position next to him.

We chat easily. I am six years old and this is my first trip alone with him. I watched earlier in the day as he stood at the podium. What seemed like thousands of Men and boys had gathered each in groups of twenty around the room. All wearing leather vests with patches and little halo's of feathers.

It was called Indian Guides...a chance for fathers and sons to spend time with other fathers and sons. To this day I can't remember exactly what we did at those meetings. Once my friend Chris and I had a contest to see who could drink the most punch. At the end my father had to pick me up and run to the bathroom so I didn't vomit on the floor.

Every year the Indian Guides would pack up and go to a special regional meeting. Usually somewhere in the Midwest. And this was my first year. My dad had somehow been elected the "Regional Chief". So while the other kids stood by their fathers I watched mine speak at the lectern. He finished the business of the afternoon and we adjourned to our cabins for rest.

Lying in bed next to my father I feel sweet fatigue wash over me. We talk about the meeting. At one point there was a shouting contest between the different "tribes". I think ours is the loudest but my father, the judge, has not yet made up his mind.

I drift off.

And to this day I have few other memories of that weekend. Few other memories of my father for that matter.

I would return to the cabin a year later for the next meeting. This time I was accompanied by my uncle.

Wednesday, June 1, 2011

It was a time before EMR's. A time before healthcare reform. And I was a new physician. In a new practice. Wet under the collar and trying to build my own brand...my own style.

So I broke tradition. I went against the grain. I separated myself from all the other physicians.

It was a big step......

I implored the medical assistants to please keep my physicals clothed so I could interview before the patient was forced into one of our oh so flattering gowns.

But Dr. V doesn't do it that way. Dr. B doesn't do it that way. They chided. Dr. G already making waves in the new practice.

But that was me....making my mark. Changing procedures and saving lives.

And they said they would follow my directions. Sure they sniggerd in the corner....but I was the doctor....the boss. They listened to my preferences and acted according.

I remember that first week in practice so well. Every patient was a learning experiance. Every encounter refreshing and new.

And my first physical. A young woman in her twenties. I burst into the room with hand extended ready to greet my new patient.

She stood still like a deer in headlights. Completely naked with her gown outstretched in one hand. Our eyes met and we both blushed....and then she held the gown in front of her body and crouched to cover as much flesh as possible.

I mumbled a quick apology and backed out the door. The medical assistants standing at the end of the hallway saw my rapid exit and began to laugh even though they didn't even know what happened.